Digital Commons Network^™

A Cooking Skills Intervention For Long-Term Weight Loss In Young Adults With Intellectual Disabilities: Rationale And Design For A Randomized Trial., Lauren T. Ptomey, Jessica C. Danon, Delwyn Catley, Richard A. Washburn, Amy Bodde, Francisco J. Diaz, Brian C. Helsel, Anna M. Rice, Joseph R. Sherman, Madison Koester, Walker S. Mckinney Ph.D., Joseph E. Donnelly

Manuscripts, Articles, Book Chapters and Other Papers

Young adults with intellectual disability (ID) are an underserved population with a high prevalence of obesity, obesity-related health conditions, and reduced ability to complete instrumental and basic activities of daily living (I/ADLs). After leaving the structured environment of public school, many young adults with ID spend more time at home or in day programs, begin living more independently, or enter the workforce. These transitions may increase reliance on fast or processed foods and reduce opportunities for physical activity, contributing to accelerated weight gain. Previous research has demonstrated clinically meaningful short- and long-term weight loss (18-24 months) in adults with mild-to-moderate …

The Effects Of An Educational Intervention To Enhance Knowledge And Awareness Of The Prevention Of Sexually Transmitted Infections Among College Students, Darcy Yates

Doctor of Nursing Practice Projects

Purpose

The DNP student implemented a single group pretest-postest design underpinned by the Health Belief Model to address the PICOT question: Among a purposive sample of college students at a mid-west college (Population) to what degree does participation in an evidence-based intervention providing information about STIs (Intervention), compared with before that intervention (Comparison), result in to an increase in knowledge and awareness regarding STI infections and associated risks and treatment options (Outcomes) over a six-week period (Time)?

Methods

The pretest and postest scores of 15 students for the 27 items in the Sexually Transmitted Diseases Knowledge Questionnaire (STD-KQ) were evaluated. …

Polyphenol Diet And Exercise As Neuroprotection From Effects Of Alzheimer's Disease, Michelle Morgan

Loma Linda University Electronic Theses, Dissertations & Projects

Healthy non-pharmacological lifestyle factors, such as regular physical exercise and a dietary supplementation, have been shown to significantly improve cognitive outcomes over time compared to a more sedentary lifestyle and poor diet. Furthermore, exercise may serve as a potential protective factor in attenuating the effects associated with cognitive decline that are characteristic of neurodegenerative disorders, such as Alzheimer's disease (AD). Further, evidence indicates that certain diet interventions can also attenuate the effects of neurodegeneration and positively impact longevity. Supplementation of polyphenols, such as ellagic acid (EA), which are abundant in pomegranate juice, may help provide neuroprotective benefits and elicit a …

The Relationship Between Depression And Cognitive Proficiency Index Across Biological Sex, Angela N. Ferdinardo

Dissertations

Depression is a widely studied mood disorder, and understanding its effect on cognitive functioning has become an important area of research. While research has examined relationships among depression, working memory, and cognitive deficits, limited research has explored depressive symptoms and cognitive proficiency across biological sex. Depression manifests similarly in men and women, though men are more likely to experience irritability, impulsivity, and anger, while women tend to experience sadness, stress, and sleep disturbances (Johns Hopkins Medicine, 2023). Women are also more likely to seek treatment and cope differently than men. This study examined the relationship between depression and cognitive proficiency …

Association Between Stress Mindset, Psychological Symptoms, And Psychosocial Risk In Liver Transplant Patients, Sarah Kay Brill

Dissertations

Psychosocial functioning is a central component of liver transplant evaluation, yet less is known about how cognitive factors, such as stress mindset, relate to transplant readiness. The present study examined the association between stress mindset and psychosocial risk, as well as its relationship with depressive symptoms, anxiety, and perceived stress among patients undergoing liver transplant evaluation. Patients included 62 adults completing standard pre-transplant assessment measures, including the Stress Mindset Measure–Specific (SMM-S), Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Perceived Stress Scale (PSS). Hierarchical logistic regression analyses indicated that stress mindset was …

Seeing The Unspoken: A Pilot Eye-Tracking Study Of Moral Injury Among Veterans, Eva M. Valdez

Dissertations

This pilot study examined associations between self-reported moral distress, state distress, combat exposure, deployment history, and maximum pupil reactivity among veterans diagnosed with PTSD. Participants viewed neutral and morally relevant images while pupil responses were recorded using eye-tracking technology. Self-report measures included moral distress severity, exposure to potentially morally injurious events, Subjective Units of Distress Scale (SUDS) ratings, total deployments, number of combat deployments, and Combat Exposure Scale scores. Maximum pupil reactivity was calculated by subtracting the mean z-scored maximum pupil response during neutral image presentations from the mean z-scored maximum pupil response during morally relevant image presentations. This variable …

Facilitating Occupational Participation In Older Adults With Chronic Pain, Emily K. Ruesch

Occupational Therapy Capstone Presentations

This capstone project developed doctoral-level clinical skills in the management of chronic pain. This capstone project also implemented a six‑week chronic pain management program for independent community‑dwelling older adults at Dow Rummel Village. Eleven adults aged 50–95 participated in weekly 45‑minute group sessions addressing adaptive equipment use, graded exercise, energy conservation, nervous system regulation, stress management, and sleep hygiene. Seven participants completed pre‑ and post‑intervention measures using the Brief Pain Inventory–Short Form and the Pain Self‑Efficacy Questionnaire. A paired samples t‑test assessed changes in pain severity, pain interference, and self‑efficacy. Results demonstrated a decrease in pain severity (t(6) = −3.96, …

Feasibility And Acceptability Of An Occupation‑Based Telehealth Intervention For Cancer Survivors: A Pilot Randomized Controlled Trial, Bernard A. Muriithi, Milan Bimali, Mario Schootman

Occupational Therapy Faculty Scholarship

Introduction

Cancer survivors frequently experience occupational performance challenges during early survivorship, and telehealth may offer a feasible approach to deliver interventions during this period.

Methods

This pilot randomized controlled trial included 17 adults in the first year following breast or prostate cancer diagnosis, assigned to the ActiveHeal Cancer Program (ACP) or a control group. ACP consisted of six 75‑minute occupation‑focused virtual group sessions and weekly follow‑up telephone calls delivered by occupational therapists over 12 weeks. Control participants attended three brief virtual meetings without therapeutic intervention. Feasibility and acceptability were assessed using validated measures, attendance, and completion rates. The exploratory outcomes …

Recover Well: Reducing Readmissions Through Nurse-Led Follow-Up After Urologic Surgery – A Quality Improvement Project, Candace Brigette Mike

Doctor of Nursing Practice Projects

Hospital readmissions within 30 days following urologic surgeries are often associated with catheter complications, infections, poor pain management, and limited patient understanding of discharge instructions and therefore represent a significant quality and safety concern for patients and institutions alike. The purpose of this quality improvement project was to evaluate whether implementing structured, nurse-led telephone follow-up in conjunction with standard discharge education reduced unplanned 30-day hospital readmissions among adult patients undergoing urologic surgery. Guided by the Logic Model framework, this project used a quasi-experimental, two-group pre- and post-intervention design to compare outcomes at a high-volume outpatient urology clinic in Houston, Texas. …

Small But Mighty: How Can Pediatric Psychologists Harness The Power Of Digital Single-Session Interventions?, Christina Amaro, Alexandra Monzon, Melissa Alderfer, Kimberly Canter, Michael Amylon, Stephanie Fooks-Parker, Jessica Schleider, Susana Patton, Katie Devine

Department of Pediatrics Faculty Papers

OBJECTIVE: Single-session interventions (SSIs) are an innovative, scalable approach for addressing the unmet behavioral and mental health needs of pediatric patients and their families. Specifically, digital SSIs, which are self-guided and delivered online, offer a low-cost and accessible approach but are currently underutilized in pediatric psychology.

METHODS: This topical review aims to describe SSIs broadly and the specific need for digital SSIs, explore potential applications within pediatric psychology, outline future directions and considerations, and present two examples of community-engaged digital SSI design.

RESULTS: SSIs evidence small to medium effects across a range of mental health concerns, including distress, anxiety, and …

A Replication Study - Mental Health And Suicide Risk Among High School Students And Protective Factors — Youth Risk Behavior Survey, United States, 2023, Hannah Baiyor

Capstone Experience: Master of Public Health

The original study (Verlenden et al., 2024) aims to analyze how various protective factors may buffer poor mental health and suicide risk outcomes among US students in grades 9-12, an important public health topic as suicide is one of the leading causes of death among US teens (Centers for Disease Control and Prevention, 2024a). Through studying these associations, this study aims to uncover pathways to positive mental health outcomes and reduced suicide risk. The study utilizes the 2023 YRBS dataset, a nationally representative sample of US public and private school students in grades 9-12, to estimate prevalence of four mental …

Enhancing Sbar Documentation And Telecommunication Between Nursing And Anesthesia Teams In The Obstetric And Labor And Delivery Unit, Apollonia C. Anderson, Celeste Meda

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Effective communication during obstetric handoffs is essential for promoting maternal and neonatal safety, yet communication failures remain a significant contributor to adverse events due to inconsistent and unstructured handoff practices. This Doctor of Nursing Anesthesia Practice (DNAP) quality improvement project was developed following the recommendations of the 2025 DNAP project, which implemented the OB/L&D-specific SBAR tool. This project evaluated the use of this communication tool in areas of OB interdisciplinary team communication accuracy, efficiency, and collaboration, particularly during obstetric epidural requests within a community-based labor and delivery unit. Guided by the Plan-Do-Study-Act (PDSA) framework (Institute for Healthcare Improvement, 2020). Utilized …

Dnp Final Report: Improving School Nurse Confidence In Managing Student Anxiety Through Simulation-Based Training, Jessica Marish

DNP Final Reports

Evidence has shown that students with untreated or poorly managed mental health concerns are at higher risk for absenteeism, psychiatric hospitalization, and school dropout. School nurses are often among the first healthcare professionals students encounter when experiencing emotional distress; however, many report limited preparation in mental health screening, grounding techniques, and referral support. The purpose of this quality improvement project was to determine the feasibility of a simulation-based educational intervention for school nurses in managing student anxiety. Guided by the Johns Hopkins Nursing Evidence-Based Practice Model and Neuman Systems Model, this initiative also included the Plan-Do-Study-Act (PDSA) quality improvement model …

Improving Knowledge Of Obesity-Related Risks And Healthy Lifestyle Behaviors In Adolescents, Tehroop Notra, Samreet Kaur, Karina Heredia

ELMSN E-Portfolio. A collection of Scholarly and Creative Works

This quality improvement project evaluated the effectiveness of a school-based educational intervention aimed at improving ninth-grade students’ knowledge and understanding of obesity prevention, nutrition, and physical activity. Adolescent obesity remains a significant public health concern, showcasing the need for early, evidence-based education. A total of 57 students participated in the two classroom sessions. Of these students, 49 completed the pre-intervention survey, and 48 completed the post-intervention survey. The intervention included an interactive presentation, group discussions, and educational materials. Student knowledge was assessed using a six-item survey administered before and after the session. The results demonstrated improvements across multiple knowledge areas, …

Weathering More Than Storms: Understanding The Mental Health Disparities Of Black Farmers In The Appalachian Region, Aliyah Smith

Electronic Theses and Dissertations

Black farmers in Appalachia represent a vital and historically marginalized population within one of America’s most economically distressed regions. Black farmers have endured generations of systemic racism, resulting in land loss, economic hardship, and mental stressors. This study examines the intersection of race, agriculture, and behavioral health to illustrate how structural barriers and cultural stigmas shape the mental well-being of Black farmers across Appalachia.

Findings from the analysis will guide the development of a conceptual model based on constructs from the Social-Ecological Model (SEM), Intersectionality Theory, and Critical Race Theory (CRT). This study will use Key Informant Interviews (KIIs) conducted …

Wisdom In Counseling And Psychotherapy: A Conceptual Model For Practice, Mitchell Waters

Papers

Wisdom is increasingly recognized as a critical construct in counseling and psychotherapy, yet it remains conceptually diffuse and underdeveloped for clinical application. This article proposes an integrative conceptual model of wisdom that extends the Dialectical Behavior Therapy (DBT) WISE MIND framework by incorporating temporal and self-transcendent dimensions. Wisdom is defined as a dynamic, context-sensitive capacity to coordinate cognitive, affective, temporal, and spiritual processes in response to complex life demands. The model includes four components: (a) cognitive–affective integration, reflecting the synthesis of emotion and reason; (b) temporal integration, involving adaptive coordination of past experiences and future possibilities; (c) self-transcendent orientation, conceptualized …

A Mindfulness-Based Stop Technique Training To Improve Nurses’ Knowledge And Self-Efficacy In Stress And Burnout Prevention, Rukiat Abolanle Afinni

Walden Dissertations and Doctoral Studies

Nurse burnout and stress are well-documented occupational concerns in outpatient clinical settings, where high patient acuity and chronic staffing shortages leave nurses with little structured support for proactive self-care. To address this gap, a mindfulness-based STOP (stop, take a breath, observe, proceed) training program was developed and evaluated for outpatient nurses. The evidence-based practice question was: Among nurses in an outpatient clinical setting, what is the impact of a mindfulness-based STOP technique training on nurses' knowledge of stress and burnout prevention and self-efficacy in applying the technique? A one-group pretest-posttest design was used with eight participants. A project-developed questionnaire measured …

The Comfort Cart Initiative: A Quality Improvement Intervention To Improve Patient Satisfaction In The Emergency Department, Heidy Cladimir Ayala

Doctor of Nursing Practice Final Project Abstract

The Comfort Cart Initiative: A Quality Improvement Intervention to Improve Patient Satisfaction in the Emergency Department

Purpose

The Comfort Cart QI project aimed to improve Emergency Department patient, parent, and guardian satisfaction by 10% over an 8-week implementation period.

Background

In healthcare, patient satisfaction is an important indicator of the quality of care provided, and many literature reviews suggest it is closely associated with patient-centered care.

 Methodology

The Comfort Cart intervention is an evidence-based quality improvement project employing a pre- and post-intervention design, conducted over an 8-week period, in the Emergency Department. The project was guided by Kolcaba's Comfort Theory …

Global Prevalence Of Depression Among University Students: A Comprehensive Umbrella Review, Gilda Yun Kai Sam, Xun Ci Soh, Harshitha Balaji, Gabriel X. D. Tan, Shu Fen Diong, Meilan Hu, Andree Hartanto, Nadyanna M. Majeed

Research Collection School of Social Sciences

Depression has become a major concern for educational institutes due to its increasing incidence and detrimental impacts on students’ well-being. However, its global prevalence in the context of tertiary education remains unclear. This umbrella review summarised existing meta-analyses and systematic reviews to examine the worldwide prevalence of depression among university students. Several sociodemographic and methodological factors, including differences in depression prevalence before, during, and after COVID-19, were examined as moderators. Structured and exhaustive searches were conducted in five bibliographic databases and five journals, alongside two sources of grey literature. A total of 61 meta-analyses and systematic reviews were included in …

A Mixed-Methods Study Of The Lived Experiences Of Patients And Caregivers Receiving Home Health Occupational Therapy Services, Peyton A. Mendias

Student Capstone Papers

Home health occupational therapy (OT) supports individuals’ safety, independence, and participation in their natural environments; however, patients and caregivers may face barriers that affect the implementation of therapy recommendations. This capstone project explored patient and caregiver experiences with home health OT and identified factors influencing implementation of OT recommendations. We used a sequential explanatory mixed-methods design guided by the Capability, Opportunity, Motivation–Behavior (COM-B) model. Eight participants, including three patients and five caregivers, completed an electronic survey, and one caregiver participated in a follow-up semi-structured interview. We analyzed quantitative data using descriptive statistics and qualitative data using reflexive thematic analysis. Findings …

The Effectiveness Of Treatment Options For Localized Prostate Cancer: A Meta-Analysis Of Cross-Sectional And Cohort Studies, Pius Omolewa, John Bressan, Nassrine Noureddine

All Faculty Scholarship

Background: Prostate cancer is one of the most common malignancies among men worldwide, with incidence rates rising steadily over the past decades. Although the widespread adoption of PSA screening has improved early detection, it has also sparked extensive debate regarding overdiagnosis and overtreatment. Against this backdrop, balancing the avoidance of unnecessary interventions with the need to ensure favorable patient outcomes has become a central challenge in clinical decision-making. Methods: Articles published from 2010 through 2025 were searched in five databases. The cross-sectional and cohort studies examined the effects of treatment options on localized prostate cancer. Results: From the analysis of …

Improving Obesity Management In Primary Care Through Provider Education, Natalie Anderson

Doctor of Nursing Practice Projects

Background: Childhood obesity is a significant public health concern associated with metabolic, cardiovascular, and psychosocial complications. Despite the availability of evidence-based pediatric obesity management guidelines, adherence to these guidelines remains inconsistent in primary care settings. Purpose: This evidence-based quality improvement project aimed to determine whether provider education on the 2023 American Academy of Pediatrics (AAP) Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity, combined with implementation of an electronic health record (EHR) clinical decision support prompt, improved provider knowledge and adherence to guideline-recommended obesity management practices. Method: A pre-post quasi-experimental study was …

Development Of An Evidence-Based Aromatherapy Policy And Toolkit For An Inpatient Psychiatric Hospital, Mia Nie

Doctor of Nursing Practice Final Project Abstract

Purpose:The purpose of this project was to develop a comprehensive, evidence-based aromatherapy policy and toolkit to guide safe and standardized use of aromatherapy as a complementary intervention in inpatient psychiatric settings.

Background: Sleep disturbances are common among psychiatric inpatients, and non-pharmacologic interventions are increasingly prioritized to support holistic care (Sazawa et al., 2022). Aromatherapy has shown potential benefits; however, the absence of standardized policies creates variability in practice and raises safety concerns, particularly in high-acuity psychiatric environments.

Methodology: This quality improvement project focused on developing an organizational policy. A review of current literature and clinical guidelines informed the foundation …

Emergency Medical Services Mental Health: Causes Of Providers Leaving The Industry, Brian C. Selke

Graduate Theses and Dissertations (2019 - present)

Employee resilience and mental health have become critical concerns in Emergency Medical Services (EMS) as workforce shortages increasingly threaten staffing stability and patient care. National Registry of Emergency Medical Technicians (NREMT) data indicates that more than 30% of eligible EMS providers did not recertify between 2020 and 2023, raising concerns about workforce sustainability. This study examines EMS providers’ intentions to leave the profession and identifies workplace factors associated with turnover. A statewide survey of more than 1,200 licensed EMS providers in Alabama was analyzed using regression techniques to evaluate the relationship between workplace conditions and turnover intentions. Results demonstrate that …

"I Can See Where This Is Taking Me": Medical Students' Perceptions Of Humanities Courses At Aga Khan University, Kenya, Catherine Gathu, Marthaclaire Zammit, Urvi Saboo, Robert Opoka

Family Medicine, East Africa

Background Humanities courses in medical training are increasingly recognized as essential for developing empathetic, reflective and socially responsive physicians. Although well-established globally, their integration into medical education in African contexts remains limited. In Kenya, humanities are often peripheral within curricula dominated by biomedical sciences and clinical medicine. Aga Khan University (AKU), Nairobi, has introduced a novel medical curriculum that embeds seven core humanities courses as central components of the initial phase of its MBChB program. This study explored students’ perceptions and lived experiences of these humanities courses.

Methods A retrospective descriptive study using an embedded mixed-methods design was conducted among …

The Effects Of Education And Training On Clinical Staff’S Knowledge, Perception, And Clinical Practice Of The Medication Reconciliation Process, Stephanie A. Williams

Doctor of Nursing Practice Projects

Medication-related harm affects approximately one in 30 patients in healthcare settings. Accurate medication reconciliation (MedRec) is essential for identifying medication discrepancies, preventing medication errors, and reducing adverse drug events. Clinical staff play a critical role in ensuring the accuracy of medication lists in primary care settings.

This evidence-based quality improvement project evaluated the effect of a structured MedRec training intervention on MedRec knowledge, perceptions, and practices among clinical staff in a primary care clinic in Southeast Texas. The project used a single-group, quantitative, quasi-experimental design. A convenience sample of 32 clinical staff members completed knowledge and perception assessments before and …

How Recent Medicaid Defunding Has Impacted San Bernardino County Residents Access To Health Care Services, Samantha I. Rios

Electronic Theses, Projects, and Dissertations

Background: Medicaid is a critical source of health insurance for low-income populations in the United States, providing access to essential preventative, primary, and reproductive health care services (Donohue et al., 2022). The Medicaid defunding of 2025 and policy changes that follow have raised concerns regarding increased barriers to care, particularly among low-income and vulnerable populations who rely on safety-net providers such as Planned Parenthood (Planned Parenthood, 2025). The purpose of this study was to examine how the 2025 Medicaid defunding has impacted access to general and reproductive health care services among residents of San Bernardino County, California.

Conclusion: The research …

A Culturally Responsive Sexual Health Education Framework For Community Clinics In The Inland Empire, Lilianna Mora Ledezma

Electronic Theses, Projects, and Dissertations

Sexually transmitted infections (STIs) continue to disproportionately affect underserved communities, where barriers such as limited healthcare access, stigma, healthcare anxiety, medical mistrust, and language differences may discourage individuals from seeking routine screening and timely treatment. This project examined current public health literature, surveillance data, and federal guidance to identify evidence-based strategies that community clinics can implement to improve patient engagement in sexual health services. The findings demonstrated that effective STI prevention extends beyond testing alone and is strengthened through culturally responsive care, stigma reduction, patient-centered communication, standardized clinic workflows, and effective patient navigation. As a result, this project developed a …

How Establishing "Duration Of Treatment" Guidelines Shortens Workers' Compensation Cases, Annette Marie Smith M.D.

Electronic Theses, Projects, and Dissertations

Jobs provide financial security for individual workers and their families in the community until a worker gets hurt on the job, and then things are up in the air until their workers’ compensation claim is approved. It is a well-known fact within the workers compensation literature that one third of all workers’ compensation (WC) claims are “low back sprains and strains” which are the leading cause of global disability (Ummey, 2023). This project proposed to explore the relationship of x-ray and MRI result interpretations by the physician and standardize the duration of treatment with a physical therapist and new concept …

Hope Kit Program, Monica Reuber

Capstone Experience: Master of Public Health

Suicide is a leading cause of death in adolescents and young adults, with a disproportionate burden of those deaths in rural areas such as Kansas. High rates of depressive symptoms, suicidal thoughts, and suicidal attempts, combined with a shortage of mental health providers, emphasize the need for community-based intervention.

This capstone is designed to develop a plan for Hope Kits, a proposed suicide prevention program, among youth in grades 7-12 in Sheridan County, Kansas to improve coping skills, promote help-seeking behavior, and reduce suicide risks.

A logic model guides the program development, which aligns with available literature and Social Cognitive …